Lower limb physiotherapist Benoy Mathew on managing running injuries with shock wave therapy

Lower limb physiotherapist Benoy Mathew on managing running injuries with shock wave therapy

Benoy Mathew is a specialist lower limb physiotherapist and a musculoskeletal sonographer. He works for the British National Health Service (NHS) at Guy’s and St. Thomas’ Hospital in London as an advanced practice physiotherapist and in private practice. 

He has a special interest in chronic hip and groin pathologies and the management of running injuries. He is passionate about the application of research in clinical practice and is the editor of the book »Hip and Knee Pain Disorders«, published in 2022.

What running injuries do you see the most of in clinic?
The majority are overuse injuries such as chronic tendinopathy and bone stress injuries. The most common tendon disorders I treat in runners are Achilles, gluteal and proximal hamstrings. I also treat conditions such as medial tibial stress syndrome using focused shock wave.

What is unique about injuries in runners compared to other patient groups?
Around 80 % of running-related injuries are overuse injuries, which means it is usually due to imbalance of tissue capacity and training load. The majority of injuries involve the knee, leg, foot and ankle. Novice runners are more likely to develop knee pain during running, whereas experienced runners tend to develop chronic tendinopathies such as Achilles or proximal hamstrings.

When did you start incorporating shock wave into your management of running injuries?
I have used shock wave in running injuries since 2015. I was finding that certain injured runners did not respond to traditional load management/strength training protocols and were still struggling with pain. This was affecting their return to running and training, which was very frustrating. I have found shock wave to be a useful evidence-based adjunct for pain reduction and to facilitate early loading and progression of exercises such as plyometrics.

What are the clinical benefits of using shock wave in runners?
I use both the STORZ MEDICAL radial and focused shock wave therapy, which bring different therapeutic benefits. Radial shock wave is useful while dealing with superficial structures like Achilles tendon and plantar fascia but is not effective for deeper structures and bone pathologies. While dealing with conditions such as shin splints, focused shock wave is the modality of choice to facilitate bone remodelling and pain relief. I find the addition of shock wave to the rehab of running injuries can enhance early return to running, in this population.

How have your running patients responded to shock wave treatment?
I find runners with Achilles and patellar tendinopathy respond well to both radial and focused shock wave. Certain conditions like proximal hamstrings tend to need more sessions (around 5 – 6) from my experience. The full recovery can take 12 – 16 weeks and it is important that runners don’t see this treatment as a quick fix. Runners should also have concurrent rehab programme, along with their shock wave treatment sessions.

How has shock wave changed your practice?
Most runners are keen to return to running at the earliest opportunity. Multiple trials have shown that the addition of shock wave therapy to a tendon loading programme in chronic lower limb tendinopathy results in a clinically important improvement, rather than just exercise therapy on its own. It is important to note that shock wave is not an isolated treatment and is always provided with education on load management, appropriate rehab and strength and conditioning to improve tissue capacity. Shock wave is simple and quick to administer and it is very safe.

This interview was kindly provided by Venn Healthcare.